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PubMed1991

External fixation of metacarpal and phalangeal fractures.

External fixation is rarely employed in the treatment of hand fractures, and few reports describing this technique have been published. This is a report on 26 patients with 30 hand fractures (19 metacarpal and 11 phalangeal) treated by closed reduction and external fixation. The fixation consisted of percutaneous and transversely applied Kirschner wires that were fixed externally with methylmethacrylate rods. Active range of motion exercises were started 1 week after reduction with the external fixator in place. Percentage return of total range of motion in phalangeal fractures varied from 66% to 98% (mean, 84%), and in metacarpal fractures it varied from 77% to 100% (mean, 96%).

Adolescent↗

PubMed1988

[Combination of external fixator and internal synthesis in fractures and pseudoarthrosis of the leg. Principle indications and results].

A combination of internal and external fixation has been used on 58 occasions in fractures and pseudarthroses in the leg. In almost two-thirds of the cases, the fractures were compound. Several situations favour this combination of fixation: internal fixation complements an initial external fixation by stabilising the fracture site in the shaft or by allowing reconstruction of joint surfaces, external fixation complements any inadequate internal fixation due to comminution of the fracture or poor skin cover that only allows a minimum of internal fixation, external fixation secondarily comes to the help of internal fixation in cases of skin necrosis or secondary bone infection. The authors believe that a combination of internal and external fixation has real advantages and that, when used with good sense, it should not lead to any specific complications.

Adolescent↗

PubMed2004

The role of external fixation in acute foot trauma.

External fixation in foot and ankle trauma has a precise indication for optimal treatment. Principles of external fixation that are integrated in the comprehensive cure of complex trauma are presented. Safe and efficient techniques also are described. The role of primary reconstruction of the overall anatomical axes and dimensions is emphasized.

Acute Disease↗

PubMed2005

Biomechanics and biology of external fixation of distal radius fractures.

External fixation is a versatile and useful tool for management of complex fractures. There is little to choose between the various types of commercially available fixators, and it is important to use one that allows the surgeon adequate versatility and follows sound biomechanical principles. Ligamentotaxis can be used effectively to reduce the most difficult fractures; however, over-distraction and prolonged traction are harmful and should be avoided. Certain types of fractures do not respond to treatment with ligamentotaxis alone and require adjunctive treatment, such as limited internal fixation. A single K-wire significantly adds to the stability of fixation and should be considered in all cases. Understanding the basic mechanical principles and respect for pin-bone biology allow for successful use of external fixation with minimal complications.

Biomechanical Phenomena↗

PubMed2001

Vascular complications after the treatment with Ilizarov external fixators.

Iatrogenic vascular injuries from external fixation in orthopaedics and traumatology are frequent. Three cases of vascular injuries after the treatment with Ilizarov external fixators were treated at our institution. These include two cases of pseudoaneurysms and one case of acute ischaemia of the lower limb. Two patients became symptomatic only after removal of the fixator. In all cases, the diagnosis was made by color flow duplex sonography. All vascular injuries needed surgical repair.

Adolescent↗

PubMed1996

[Osteosynthesis of tibial valgus osteotomies by goniometric CH-N external fixator].

INTRODUCTION: The authors present technique and results of a new external fixator, the < < goniometric > > external fixator CH-N for osteosynthesis of high tibial osteotomy for arthritic varus knee deformity on 86 kness (75 patients). MATERIALS AND METHODS: 86 knees in varus deformity with degenerative arthritis of the medial compartment (56 females and 16 males - age 63 +/-8 years) were treated for 5 years (1989-1993) by high tibial osteotomy stabilized by a < < goniometric > > external fixator CH-N. RESULTS: Clinical results were 65,9 per cent excellent, 17, 1 per cent good, 11,8 per cent fair and 5,2 per cent poor 1 year after osteotomy (86 cases analyzed), changing in 60 per cent excellent, 22,3 per cent good, 9, 1 per cent fair and 8,5 per cent at 3 years follow-up (61 cases). Radiological results were: - The preoperative mechanical axis of 13 degrees +/- 5 degrees in varus transformed to 4 degrees +/- 2 degrees in valgus at consolidation and to 2,5 degrees +/- 3 degrees in valgus at one year follow-up. At 3 years follow-up we founded a new loss of correction of 1 degree (mean) in 22 per cent of cases (61 cases). - Subchondral density decreased in 91 per cent of cases (86 cases) one year after and in 82 per cent of cases, 3 years after the osteotomy (61 cases). - In 12 per cent of cases we found a decrease of the overcorrectional angle of the varus deformity 1 year after, and in 22 per cent of cases 3 years after. Two cases needed total knee arthroplasty 4 years after ostcotomy. - Postoperatively, in 86 per cent of cases we did not found increase in both clinical and radiological (pathological) findings of the patellofemoral joint one year after, and in 75 per cent of cases 3 years after. DISCUSSION: The principle of this special < < goniometri > > external fixator is based on the < < goniometric > > central joint in the frontal plane, this allows to guide the screws during osteotomy in the predesigned position and to control the correction during and after the procedure, in contrary to the others current system either internal or external. Any faulty correction can be modified. With its distal screwing axis, it allows axial dynamization. There are only some but not serious incoveniences due to the application of pins (temporary neuromuscular problems and pin-track infections.

Aged↗

PubMedDate not supplied

Comparison of dynamic versus static external fixation for pediatric femur fractures.

External fixation of pediatric femoral shaft fractures has the advantages of minimal dissection and early weight bearing. However, it is associated with slow healing and potential for refracture. Some surgeons have proposed that axial dynamization may improve the speed and strength of callus formation. to test this hypothesis, we performed a randomized controlled trial using 53 femur fractures in 52 patients between 1995 and 1999. Patients were randomized to receive dynamic or static fixation. Average time until early callus formation was 23.2 days for dynamic fixation and 24.9 days for static fixation (P = 0.627). Average time until complete radiographic healing was 70.1 days for dynamic fixation and 63.1 days for static fixation (P = 0.370). Similarly, the differences in time to fixator removal and to full weight bearing did not reach statistical significance. The conclusion was that axial dynamization of external fixation for pediatric femur fractures has no significant effect on time to healing or frequency of complications.

Child↗

PubMed2002

Mechanical strength and wear of used EBI external fixators.

Thirty-one EBI external fixators (Dynafix; EBI, Parsippany, NJ) subjected to one or two clinical uses underwent static mechanical testing identical to that performed on new devices prior to market approval. No fixator exhibited catastrophic mechanical failure. For all fixators tested, the mean load to failure was not significantly different from that of identical testing of new devices. Although loss of material from serrated joints was observed in some joints, mechanical strength was not affected. Additional testing of fixators of a variety of designs is necessary to expand on the results of this investigation. The results of this study represent a first step in validating the safety of external fixator component reuse.

Equipment Failure↗

PubMed1995

Intramedullary nailing after external fixation of the tibia.

Intramedullary nailing after external fixation of fractures of the tibia has high complication rates including nonunion and infection. The authors review the literature regarding this technique and refine the indications for secondary IM nailing. The report distinguishes between sequential secondary nailing and reconstructive secondary nailing. Sequential secondary nailing, as defined, is done by protocol and is planned from the onset of treatment. The technique includes only a short period in the external fixator, a planned interval between removal of the frame and placement of the IM nail, and specific exclusion criteria. This technique essentially uses the external fixator as a temporary traction device while the soft tissue envelope is reconstructed. Reconstructive procedures, as defined, are not done by protocol and not planned from the onset of treatment. Patients are usually in the external fixator for extended periods of time. The indications are variable and include delayed union, nonunion, malunion, and infected nonunion. The authors conclude that when done by protocol sequential IM nailing is safe and effective. Reconstructive IM nailing, however, has strict contraindications that include: a history of or an active infection of the pin tract, wound, or bone; the presence of an open wound or pin tract; and the presence of a ring or halo sequestrum. Yet reconstructive secondary procedures can be effective in healthy individuals if the soft tissue envelope is completely reestablished, if antibiotics are administered preoperatively, and the nail is placed without reaming.

Adult↗

PubMed2000

External fixation in forearm shaft fractures.

External fixation for uncomplicated forearm fractures is rarely performed. The situation is different in a multiply injured patient or in a fracture with considerable soft tissue damage. In these cases the external fixator confers quick and efficient stabilisation which meets the requirements of adequate nursing and aids recovery of the general and local condition. Later change to an appropriate internal fixation procedure for definitive fracture treatment is recommended.

Adolescent↗

PubMed2004

External fixation of Charcot arthropathy.

Deformity, instability, and ulceration are present in a high percentage of patients who have Charcot arthropathy. Traditional treatment of these conditions has consisted of debridement, antibiotics, and immobilization with limited weight bearing. These measures are followed by long-term use of various foot and ankle bracing devices, such as the CROW walker, double metal upright, and the lined clam shell AFO with accommodative footwear either incorporated or attached. Sometimes these conservative measures fail and surgery is indicated for foot and ankle deformities with: (1) unbraceable deformity; (2) recurrent ulceration secondary to deformity, instability, or both; and (3) Charcot arthropathy with pain that is unresponsive to conservative measures. Certain acute traumatic situations with impending deformity also may benefit from early surgical stabilization. High deep infection rates (25%) have been reported in surgical reconstruction of feet that have a history of ulceration. The high rates of infection with internal fixation techniques and improved external fixation devices have led surgeons to consider external fixation as a viable alternative for: (1) singlestage correction of a limb with recent or current ulceration; (2) revision or salvage of previously reconstructed limbs; and (3) acute treatment of insufficiency type fractures (impending Charcot arthropathy) in the diabetic who has severe peripheral neuropathy with or without adjuvant internal fixation.

Arthropathy, Neurogenic↗

PubMed1993

Dynamic external fixation of distal radius fractures.

External fixation in fractures of the distal radius has been used for almost 80 years. The main objective is to achieve reduction and maintain the reduction throughout treatment. The fixator concept described as the dynamic fixator allows reduction in three planes and allows for the wrist to move after a period of rigid fixation. Fixator application is illustrated for fractures that necessitate bridging of the wrist joint and for extra-articular fractures. Indications for additional measures, including bone grafting, k-wire fixation, and stabilization of the radioulnar joint, are discussed. Associated injuries and postoperative management is described. The technique of correcting malunited fractures with the assistance of an external fixator is explained, with special emphasis on the correction of radial length, angle, and shift. The results of initial trials show a low complication rate and indicate that bone grafting should probably be used more than previously recommended.

Bone Screws↗

PubMed2002

[Tensile strength of bone fixation of hydroxyapatite coated Schanz screws of the Heidelberg External Fixation System (HEFS)--comparative torque measurements in clinical use and in cadaver tibia].

It is claimed in the literature that hydroxyapatite(HA)-coated screws of external fixators have superior fixation strength in bone, which is postulated to lead to a substantial decrease in loosening and infection rates. We report on a study of the maximum torque values developed while inserting and removing 30 HA-coated Schanz screws of 8 Heidelberg external fixation systems applied to the tibia to correct leg length differences and axial deformities. The infection rate was determined in accordance with defined criteria, and was found to be about 20% for the HA-coated screws. Screws without infection showed an extraction torque above insertion torque, screws with infection an extraction torque below. A significant correlation (p = 0.05) was seen between infection and decrease in fixation strength (quotient: loosening torque/tightening torque). To exclude the impact of such biological processes as osteointegration and bone remodelling, the clinical results were compared with the torques measured for coated and uncoated Schanz screws in a human cadaveric tibia. A significantly higher fixation strength in bone was found for HA-coated screws in comparison with uncoated screws (p = 0.002). These data warrant a clinical study directly comparing HA-coated and uncoated Schanz screws.

Bone Remodeling↗

PubMed2005

A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures.

PURPOSE: External fixation and open reduction and internal fixation have been the traditional techniques for surgical fixation of unstable distal radius fractures. The existing literature has not identified which is superior, primarily because of the lack of comparative trials. We performed a comprehensive systematic review and meta-analysis of the current literature on external fixation and internal fixation of distal radius fractures to determine the dominant strategy based on available scientific evidence. METHODS: We searched MEDLINE and EMBASE for English-language articles published between 1980 and 2004 that satisfied predetermined inclusion and exclusion criteria. The outcomes of internal and external fixation were compared using continuous measures of grip strength, wrist range of motion, and radiographic alignment and categoric measures of pain, physician-rated outcome scales, and complication rates. Outcomes were pooled by random-effects meta-analysis and meta-regression analysis was used to control for patient age, presence of intra-articular fracture, duration of follow-up period, and date of publication. Sensitivity analyses were used to test the stability of the meta-analysis results under different assumptions. RESULTS: Forty-six articles were included in the review with 28 (917 patients) external fixation studies and 18 (603 patients) internal fixation studies. Meta-analysis did not detect clinically or statistically significant differences in pooled grip strength, wrist range of motion, radiographic alignment, pain, and physician-rated outcomes between the 2 treatment arms. There were higher rates of infection, hardware failure, and neuritis with external fixation and higher rates of tendon complications and early hardware removal with internal fixation. Considerable heterogeneity was present in all studies and adversely affected the precision of the meta-analysis. CONCLUSIONS: The current literature offers no evidence to support the use of internal fixation over external fixation for unstable distal radius fractures. Comparative trials using appropriately sensitive and validated outcome measurements are needed to guide treatment decisions.

Bone Plates↗

PubMed1983

Stress-protection after external fixation on the intact rabbit tibia.

Bone loss due to the stress-protecting effect of a metal plate on intact bone is a well-known phenomenon. The purpose of the present study was to find whether a similar effect is caused by external fixation. External mini-fixation was applied on the intact rabbit tibial diaphysis of one leg. The other tibia served as control. The animals were sacrificed after 6 or 12 weeks, and both tibiae biomechanically tested in three-point bending. The bone mineral content was measured by photon absorptiometry. No significant changes in bone strength, stiffness or mineral content were found after 6 weeks. The strength and stiffness were significantly reduced after 12 weeks. The median strength and stiffness at that time were 87 and 88 per cent, respectively, in relation to the control bones. The mineral content in the bone segment which had been stabilized by external fixation was significantly reduced after 12 weeks (median 90 per cent of the values for the control bones). No significant change in the mineral content occurred at a level in the tibial diaphysis distal to the external fixation device. It is concluded that the stress-protecting effect caused by external mini-fixation on the rabbit tibia occurs later, and is less pronounced, than that caused by metal plates.

Animals↗

PubMed1993

Analysis of the external fixator pin-bone interface.

External fixator pins were inserted into tibiae of dogs under four in vivo loading conditions to examine the mechanism of pin loosening. Pins were quantitatively measured for pin torque resistance, and the pin tracts were studied radiographically and histologically. The pins holding an unstable fracture had more gross pin loosening. Pins also may become loose under static loads. Radiographic lucency of 1 mm or more in the cortical bone around a pin was evidence of gross pin loosening. Histologic examination showed that tight pin tracts were characterized by a lack of bone remodeling. Loose pin tracts were characterized by extensive bone resorption and inflammatory infiltrates. Pin loosening can be detected radiographically. Pin insertion technique is important to improve the initial pin torque resistance to minimize pin loosening. Sixty-nine percent of pins with an initial torque resistance of less than 68 Ncm became grossly loose compared with only 9% of pins with an initial torque resistance greater than 68 Ncm, regardless of the experimental group. Unstable external fracture fixation is another important factor in producing pin loosening. Pins loaded under unstable fracture fixation had the highest incidence of gross loosening. When applying an external fixator, the fracture rigidity should be critically evaluated and, if necessary, protected weight bearing must be introduced initially to minimize pin loosening.

Animals↗

PubMed2005

External fixation in comminuted, displaced intra-articular fractures of the distal radius: is it sufficient?

INTRODUCTION: External fixation has been extensively used to treat the intra-articular fractures of the distal radius and it has several distinct advantages over conventional POP cast and plate fixation. However, the limitation of external fixation to achieve articular congruity in the comminuted intra-articular fractures of the distal radius has been documented in the literature. This could be because external fixation alone does not expand crushed cancellous bone and cannot work without soft tissue hinges. This prospective study was conducted to look at the results of comminuted, displaced intra-articular fractures of the distal radius treated exclusively by external fixation. MATERIALS AND METHODS: A 2-year follow-up of 27 patients with comminuted, displaced intra-articular fractures of distal radius that were treated exclusively by external fixation is presented. The radiological results, functional results and complications were analyzed according to the scoring system given by Jakim et al. RESULTS: Anatomical reduction could not be achieved in 12 patients (44%) and reduction was lost in two patients (7%). Excellent and good results were seen in 59.3%, fair results were seen in 22.2% and poor results were seen in 18.5% of the cases. Outcome scores of patients without articular step were significantly better as compared to the patients with articular step at healing. There was a positive correlation between the restoration of normal anatomy (radiological results) and the functional outcome (r=0.775). Overall nine patients (33%) had complications. CONCLUSION: We conclude that although the external fixation is reliable in maintaining the reduction in displaced comminuted intra-articular fractures, it is inadequate in restoring articular congruity in many cases. The complications of external fixation are frequent and may be potentially serious in nature.

Adolescent↗

PubMed2006

The use of external fixation for the treatment of spine infection with Actinomyces bacillus.

OBJECTIVE: External fixation can be used for stabilization of the spine in salvage cases, especially in cases of infection of the spine. The advantages of this method are avoiding the needs for internal fixation devices and for postoperative bracing. The literature on this is scant. Reported is a rare case of osteomyelitis of the D2 vertebra with an epidural abscess caused by Actinomyces israelii that spread from the lung and was treated by decompression and external fixation. METHODS: A 51-year-old man with right upper lobe pneumonia due to A. israelii coccobacillus developed osteomyelitis of the D2 vertebra and an epidural abscess with a gradual paraparesis. He underwent a laminectomy of D1-D3 and 3 weeks later stabilization of the upper thoracic spine using a tubular external fixator that was inserted from C7-D1 to D3-D4. The patient was treated with antibiotic intravenously and later orally. After 2 months, the external fixator was removed. RESULTS: At the last follow-up, the patient had no fever, the erythrocyte sedimentation rate and C-reactive protein level had normal values, and there was only a slight limitation in the range of motion of the cervical paraparesis. Radiography and magnetic resonance imaging demonstrated stabilization of the affected segment without any sign of active osteomyelitis. There were no complications associated with the use of the external fixator. CONCLUSIONS: The use of external fixation offers an appropriate alternative for stabilization of the spine as a salvage procedure. The procedure could be performed easily and without any major complications. Especially for the treatment of complicated cases of spinal infection, the use of an external fixator can be of great benefit.

Actinomycosis↗